Avaliação dos desfechos polissonográficos, cefalométricos e de qualidade de vida dos pacientes com apneia obstrutiva do sono submetidos ao avanço maxilomandibular

Abstract

Introduction: Obstructive sleep apnea presents itself as a public health problem with increasing prevalence and association with increased cardiovascular morbidity and mortality, with the need for adequate control and treatment. Maxillomandibular advancement is considered the most effective surgical treatment for patients with severe conditions who have not adapted to airway ventilation with continuous positive pressure. However, polysomnographic, cephalometric and quality of life outcomes are still poorly studied. Objective: To evaluate polysomnographic, cephalometric and health-related quality of life data of patients diagnosed with moderate and severe obstructive sleep apnea undergoing maxillomandibular advancement. Method: Between August 2018 and February 2023, thirty-eight patients with moderate and severe obstructive sleep apnea who underwent maxillomandibular advancement were evaluated in the preoperative period and six months after surgery. Polysomnography, cephalometry and quality of life questionaries (Medical Outcomes Study 36 instruments - Item Short-Form Health Survey, Functional Outcomes of Sleep Questionnaire and Epworth Sleepiness Scale) were used. Results: In the postoperative period there was a reduction in the average apnea and hypopnea index (59.7 events/hour to 10.4 events/hour, p<0.01), an increase in minimum saturation (72.3% to 89.2% , p<0.05), increased percentage of REM sleep (11.3% to 17.7%, p<0.05) and increased anterior maxillary angles (SNA: 78.36 degrees to 84.92 degrees , p<0.05) and mandibular angles (SNB: 74.7 degrees to 80.8 degrees, p<0.05). Patients undergoing maxillomandibular advancement had less daytime sleepiness: 6.4 (±5.65) versus 14.5 (±7.26), p<0.01; better overall quality of life indexes in the domains: physical aspects: 77.3 (±37.72) versus 50.9 (±42.21), p<0.05; vitality: 70.2 (±20.61) versus 45.9 (±26.7), p<0.01; mental health: 75.8 (±16.40) versus 58.1 (±24.5), p<0.01; social aspects: 83.8 (±15.53) versus 65.8 (±29.84), p<0.05; and better sleep-related quality of life indices in the general productivity domains: 3.7 (±0.50) versus 2.9 (±0.91), p<0.01; social function: 3.9 (±0.30) versus 3.0 (±1.15), p<0.01; activity level: 3.6 (±0.28) versus 2.7 (±1.00), p<0.01; surveillance: 3.8 (±0.31) versus 2.7 (±1.02), p<0.01 and interpersonal and sexual relationships: 3.6 (±0.73) versus 2.8 (±1, 18), p<0.01; when compared to the preoperative period. Conclusion: Maxillomandibular advancement proved to be an effective treatment for controlling obstructive sleep apnea with improvement in polysomnographic and cephalometric parameters and patients had better general and sleep-related quality of life six months after surgery.